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HomeMy WebLinkAboutC16-041 Jessica WaclawskiAGREEMENT FOR PROFESSIONAL SERVICES BETWEEN EAGLE COUNTY, COLORADO AND JESSICA WACLAWSKI, LCSW r'c '' THIS AGREEMENT ('Agreemenf') is effective as of the ( Oay of (vt\tt's*/4 ,2}t6by and between Jessica Waclawski, LCSW (hereinafter "Consultant'' or "Contractor") and Eagle County, Colorado, a body corporate and politic (hereinafter "County"), RECITALS WIIEREAS, the County, through its Deparfnent of Health and Human Services ("HHS") works to promote the health, safety and welfare of County residents of all ages; and WHEREAS, the County uses outside providers and professionals to enhance the ability of County to promote such health, safety and welfare; and WIIEREAS, County desires to hire the Consultant to perform the Services defined below in paragraph l; and WI{EREAS, Consultant is authorized to do business in t}re State of Colorado and has the time, skill, expertise, and experience necessary to provide the Services; and WHEREAS, this Agreement shall govem the relationship between Consultant and County in connection with the Services. AGREEMENT NOW, TI{EREFORE, in consideration of the foregoing and the following promises Consultant and County agree as follows: 1. Services. Consultant agrees to diligently provide all services, labor, personnel and materials necessary to perform and complete the services described in Exhibit A ("Services") which is attached hereto and incorporated herein by reference. The Services shall be performed in accordance with the provisions and conditions of this Agreement. a. Consultant agrees to fumish the Services in accordance with the schedule established in Exhibit A. If no completion date is specified in Exhibit A, then Consultant agrees to furnish the Services in a timely and expeditious manner consistent with the applicable standard of care. By signing below Consultant represents that it has the expertise and personnel necessary to properly and timely perform the Services. Eagle County Ccmmissioners' Office C16-041 b. In the event of any conflict or inconsistency between the terms and conditions set forth in Exhibit A and the terms and conditions set forth in this Agreement, the terms and conditions set forth in this Agreement shall prevail. c. Consultant agrees that it will not enter into any consulting or other arangements with third parties that will conflict in any manner with the Services. 2. County's Representative. The Human Services Department's designee shall be Consultant's contact with respect to this Agreement and performance of the Services. 3. Term of the Agreement. This Agreement shall cornmence upon the date first written above, and subject to the provisions ofparagraph 11 hereof, shall continue in full force and effect through the 31" day of December,2016. 4. Extension or Modification. This Agreement may not be amended or supplemented, nor may any obligations hereunder be waived, except by agreement signed by both parties. No additional services or work performed by Consultant shall be the basis for additional compensation unless and until Consultant has obtained written authorization and acknowledgement by County for such additional services in accordance with County's internal policies. Accordingly, no course of conduct or dealings between the parties, nor verbal change orders, express or implied acceptance of alterations or additions to the Services, and no claim that County has been unjustly enriched by any additional services, whether or not there is in fact any such unjust enrichment, shall be the basis of any increase in the compensation payable hereunder. In the event that written authorization and acknowledgment by County for such additional services is not timely executed and issued in strict accordance with this Agreement, Consultant's rights with respect to such additional services shall be deemed waived and such failure shall result in non-payment for such additional services or work performed. 5. Compensation. County shall compensate Consultant for the performance of the Services in a sum computed and payable as set forth in Exhibit A. The performance of the Services under this Agreement shall not exceed $12,500.00. Contractor shall not be entitled to bill at overtime and/or double time rates for work done outside of normal business hours unless specifically authorized in writing by County. a. For reimbursement Contractor must subrnit invoices monthly.Invoices shall include a description of Services performed. If County is not satisfied with the completeness of a submitted invoice, County may request Conffactor to either revise the invoice or provide additional information. Payment will be made for Services satisfactorily performed within ttlirty (30) days of receipt of a proper and accurate invoice. All invoices shall include deail regarding the hours speng tasks performed, who performed each task and such other detail as County may request. All invoices must be mailed or delivered in-person to the following address to ensure proper paymenl Invoices sent by fax will not be accepted. Eagle County Health and Human Services Business Office 2 Eagle County HHS Prof Serv Enallll4 550 Broadway Post Office Box 660 Eagle, CO 81631 Any out-of-pocket expenses to be incurred by Consultant and reimbursed by County shall be identified on Exhibit A. Out-of-pocket expenses will be reimbursed without any additional mark-up thereon and are included in the not to exceed contract amount set forth above. Out-of-pocket expenses shall not include any payment of salaries, bonuses or other compensation to personnel of Consultant. Consultant shall not be reimbursed for expenses that are not set forth on Exhibit A unless specifically approved in writing by County. c. If, prior to payment of compensation or reimbursement for Services but after submission to County of a request therefore by Contractor, County reasonably determines that payment as requested would be improper because the Services were not performed as prescribed by the provisions of this Agreement, the County shall have no obligation to make such payment. If, at any time after or during the term or after termination or expiration of this Agreement, County reasonably determines that any payment theretofore paid by County to Confactor was improper because the Services for which payment was made were not performed as set forth in this Agreement, then upon written notice of such determination and request for reimbursement from County, Consultant shall forthwith return such payment(s) to County. Upon termination or expiration of this Agreement, unexpended funds advanced by County, if any, shall forthwith be retumed to Countv. d. All funds received by Confractor under this Agreement shall be or have been expended solely for the purpose for which granted, and any funds not so expended, including funds lost or diverted for other purposes, shall be returned to County. Conftactor shall provide the County with progress reports upon County's request; or Conffactor shall furnish progress reports as more specifically set forth in the attached Exhibit A. County will not withhold any taxes from monies paid to the Consultant hereunder and Consultant agrees to be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant to the terms of this Agreement. f. Notwithstanding anything to the conffary contained in this Agreement, County shall have no obligations under this Agreement after, nor shall any payments be made to Consultant in respect of any period after December 31 of any year, without an approprtation therefor by County in accordance with a budget adopted by the Board of County Commissioners in compliance with Article 25, title 30 of the Colorado Revised Statutes, the Local Govemment Budget Law (C.R.S .29-l-l0l et. seq.) and the TABOR Amendment (Colorado Constitution, Article X, Sec. 20). Sub-consultants. Consultant acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Consultant. Consultant shall not enter into any sub-consultant agreements for the performance of any of the Services or additional services without County's prior written consent, which may be withheld in County's sole discretion. County shall have the right in its reasonable discretion to approve all personnel assigned to the subject project during the 3 Eagle County HHS hof Serv Final 5/14 perfonnance of this Agreement and no personnel to whom County has an objection, in its reasonable discretion, shall be assigned to the project. Consultant shall require each sub+onsultant, as approved by County and to the extent of the Services to be performed by the sub-consultant, to be bound to Consultant by the terms of this Agreement, and to assume toward Consultant all the obligations and responsibilities which Consultant, by this Agreement, assumes toward County. County shall have the right (but not the obligation) to enforce the provisions of this Agreement against any sub-consultant hired by Consultant and Consultant shall cooperate in such process. The Contractor shall be responsible for the acts and omissions of its agents, employees and sub-consultants or sub-conffactors. 7. Insurance. Consultant agrees to provide and maintain at Consultant's sole cost and expense, the following insurance coverage with limits of liability not less than those staf€d below: a, Types oflnsurance. l Workers' Compensation insurance as required by law. Personal Auto insurance as required by law. iii. Commercial General Liabiliry coverage to include premises and operations, personal/advertising rnjury, products/completed olnrations, broad form property damage with limits of liabiliy not less than $1,000,000 per occuffence and $2,000,000 aggregate limits. This policy shall be endorsed to include coverage for physicaUsexual abuse and molestation. Professional liability insurance with prior acts coverage for all Services required hereunder, in a form and with an insurer or insurers satisfactory to County, with limits of liability of not less than $1,000,000 per claim and $2,000,000 in the aggregate. In the event the professional liability insurance is on a claims-made basis, Consultant warrants that any retroactive date under the policy shall precede the effective date of this Agreement. Continuous coverage will be maintained during any applicable statute of limitations for the Services. v. Third party fidelity/crime coverage including coverage for theft and mysterious disappearance. The policy shall include coverage for all directors, officers, agents and employees of the Consultant. The policy shall name Eagle County and Eagle County's clients as loss payee as their interests may appear. The policy shall not contain a condition requiring an arrest or conviction. Policies shall be endorsed to provide coverage for computer crime/fraud. b. OtherRequirements. The commercial general liability coverage and such other coverage as indicated above shall be endorsed to include Eagle County, its associated or affiliated entities, its successors and assigns, elected officials, employees, agents and volunteers as additional insureds. ii. Consultant's certificates of insurance shall include sub-consultants as additional insureds under its policies or Consultant shall t-umish to County separate certificates and endorsements for 4 EagJe County HHS Prof Serv Final 5/14 each sub-consultant. All coverage(s) for sub-consultants shall be subject to the same minimum requirements identified above. Consultant and sub+onsultants, f *y, shall maintain the foregoing coverage in effect until the Services are completed. In addition, all such policies shall be kept in force by Consultant and its sub'consultants until the applicable statuk of limitations for the Services has expired. iii. Insurance shall be placed with insurers duly licensed or authorized to do business in the State of Colorado and with an "A.M. Besf'rating of not less than A-VII. iv. Consultant's insurance coverage shall be primary and non-contributory with respect to all other available sources. Consultant's policy shall contain a waiver of subrogation against Eagle County. v. A1l policies must contain an endorsement affording an unqualified thirty (30) days notice of cancellation to County in the event of cancellation of coverage. vi. All insurers must be licensed or approved to do business within the State of Colorado and all policies must be written on a per occunence basis unless otherwise provided herein. vii. Consultant's certificate of insurance evidencing all required coverage(s) is attached hereto as Exhibit B. Upon request, Consultant shall provide a copy of the actual insurance policy and/or required endorsements required under this Agreement within five (5) business days of a written request from County, and hereby authorizes Consultant's broker, without further notice and authorization by Consultant, to immediately comply with any written request of County for a complete copy of the policy. viii. Consultant shall advise County in the event the general aggregate or other aggregate limits are reduced below the required per occuffence limit. Consultant, at its own expense, will reinstate the aggregate limits to comply with the minimum limits and shall fumish County a new certificate of insurance showing such coverage. ix. If Consultant fails to secure and maintain the insurance required by this Agreement and provide satisfactory evidence thereof to County, County shall be entitled to immediately terminate this Agreement. x. termination hereof. The insurance provisions of this Agreement shall survive expiration or xi. The parties hereto understand and agree that the County is relying on, and does not waive or intend to waive by any provision of this Agreement, the monetary limitations or rights, immunities and protections provided by the Colorado Governmental Immunity Act, as from time to time amended, or otherwise available to County, its affiliated entities, successors or assigns, its elected officials, employees, agents and volunteers. Consultant is not entitled to workers' compensation benefits except as 5 Eagle County IIHS ProfServ Final 5i14 xl1. provided by the Consultant, nor to unemployment insurance benefits unless unemployment compensation coverage is provided by Consultant or some other entity. The Consultant is obligated to pay all federal and state income tax on any moneys paid pursuant to this Agreement. 8' Indemnification. The Consultant shall indemnify and hold harmless County, and any of its officers, agents and employees against any losses, claims, damages or liabilities for which County may become subject to insofar as any such losses, claims, damages or liabilities arise out of, directly or indirectly, this Agreement, or are based upon any performance or nonperformance by Consultant or any of its sub-consultants hereunder including claims for bodily rnjury or personal injury including death, or loss or damage to tangible or intangible property; and Consultant shall reimburse County for reasonable attomey fees and costs, legal and other expenses incurred by County in connection with investigating or defending any such loss, claim, damage, liability or action. This indenurification shall not apply to claims by third parties against the County to the extent that County is liable to such third party for such claims without regard to the involvement of the Consultant. This paragraph shall survive expiration or termination hereof. 9. Ownership of Documents. All documents prepared by Consultant in connection with the Services shall become property of County. Consultant shall execute writfen assignments to County of all rights (including contmon law, statutory, and other rights, including copyrights) to the same as County shall from time to time request. For purposes of this paragraph, the term "documents" shall mean and include all reports, plans, studies, tape or other elecffonic recordings, drawings, sketches, estimates, data sheets, maps and work sheets produced, or prepared by or for Consultant (including any employee or subconfractor in connection with the performance of the Services and additional services under this Agreement). 10. Notice. Any notice required by this Agreement shall be deemed properly delivered when (i) personally delivered, or (ii) when mailed in the United States mail, fir'st class postage prepaid, or (iii) when delivered by FedEx or other comparable courier service, charges prepaid, to the parties at their respective addresses listed below, or (iv) when sent via facsimile so long as the sending party can provide facsimile machine or other confirmation showing the date, time and receiving facsimile number for the ffansmission, or (v) when transmitted via e-mail with confirmation of receipt. Either party may change its address for purposes of this pmagraph by giving five (5) days prior written notice of such change to the other party. COUNTY: Eagle County, Colorado Attention: Maggie Swonger 500 Broadway Post Office Box 660 Eagle, CO 81631 Telephone : 97 0 -328 -26A9 E-Mail: Maggie. swonger@eaglecounty.us With a copy to: 5 Eagle County HHS Prof Serv Final5/I4 Eagle County Attorney 500 Broadway Post Office Box 850 Eagle, Co 81631 Telephone: 970-328-8685 Facsimile: 97 0-328-8699 E-Mail: atty @ eaglecounty.u s CONSULTANT: Jessica TVaclawski, LCSW PO Box 1776 Avon, CO 81620 Telephone: 303-7 17-0801 E-Mail: jessicawacl awski@ gmail.com 11. Termination. County may terminate this Agreement, in whole or in part, at any time and for any reason, with or without cause, and without penalty therefor with thirty (30) calendar days' prior written notice to the Consultant. Upon termination of this Agreement Consultant shall immediately provide County with all documents as defined in paragraph t hereof, in such format as County shall direct and shall return all County owned materials and documents. County shall pay Consultant for Services satisfactorily performed to the date of termination. 12. Venue. Jurisdiction and Applicable Law. Any and all claims, disputes or controversies related to this Agreement, or breach thereof, shall be litigated in the Disrict Court for Eagle County, Colorado, which shall be the sole and exclusive forum for such litigation. This Agreement shall be construed and interpreted under and shall be governed by the laws of the State of Colorado. 13. Execution by Counterparts: Elecffonic Signatures. This Agreement may be executed in two or more counterparts, each of which shall be deemed an original, but all of which shall constitute one andthe same insffument. The parties approve the use of electronic signatures for execution of this Agreement. Only the following two forms of elecffonic signatures shall be permitted to bind the parties to this Agreement: (i) Electronic or facsimile delivery of a fully executed copy of the signature page; (ii) the image of the signature of an authorized signer inserted onto PDF format documents. All documents must be properly notarized, if applicable. All use of electronic signatures shall be governed by the Uniform Electronic Transactions Act. C.R.S.2+7L3-10I to I2l. 14. Other Contract Requirements. a. In rendering the Services hereunder, Contractor shall comply with the highest standards of customer service to the public. Conffactor shall provide appropriate supervision of its employees to ensure the maintenance of ttrese high standards of customer service and professionalism are maintained. The performance of such obligation shall be determined at the sole discretion of County. In the event 7 Eagle County IIHS Prof Serv Final 5lI4 County finds these standards of customer service are not being met by Contractor, County may terminate this Agreement, in whole or in part, upon seven (7) days' notice to Contractor. b. Consultant shall be responsible for the completeness and accuracy of the Services, including all supporting data or other documents prepared or compiled in performance of the Services, and shall coffect, at its sole expense, all significant errors and omissions therein. The fact that the County has accepted or approved the Services shall not relieve Consultant of any of its resporrsibilities. Consultant shall perform the Services in a skillful, professional and competent manner and in accordance with the standard of care, skill and diligence applicable to Consultants performing similar services. This pamgaph shall survive termination of this Agreement. c. Consultant represents and wa:rants that it has the expertise and personnel necessary to properly perform the Services and covenants that its professional personnel are duly licensed to perform the Services within Colorado. d. Consultant agrees to work in an expeditious manner, within the sound exercise of its judgment and professional standards, in the performance of this Agreement. Time is of the essence with respect to this Agreement. e. This Agreement constitutes an agreement for performance of the Services by Consultant as an independent confractor and not as an employee of County. Nothing contained in this Agreement shall be deemed to create a relationship of employer-employee, rnster-servant, parfircrship, joint venture or any other relationship between County and Consultant except that of in&pendent conftactor. Consultant shall have no authoriw to bind Countv. f. Consultant represents and warrants that at all times in the performance of the Services, Consultant shall comply with any and all applicable federal and state laws, codes, rules andregulations. g. Conffactor shall comply with the Civil Rights Act of 1964 and Section 504, Rehabilitation Act of 1973, concerning discrimination on the basis of race, color, sex, age, religion, political beliefs, national orign or handicap. h. This Agreement contains the entire agreement between the parties with respect to the subject matter hereof and supersedes all other agreements or understanding between the parties with respect thereto. i. Consultant shall not assign any portion of this Agreement without the prior written consent of the County. Any attempt to assign this Agreement without such consent shall be void. j. This Agreement shall be binding upon and shall inure to the benefit of the parties hereto and their respective permitted assigns and successors in interest. Enforcement of this Agreement and all rights and obligations hereunder are reserved solely for the parties, and not to any third party. 8 Eagle Couffy fIH$Prof Serv Final Vl4 k. No failure or delay by either party in the exercise of any right hereunder shall constitute a waiver thereof. No waiver of any breach shall be deemed a waiver of any preceding or succeeding breach. l. The invalidity, illegality or unenforceability of any provision of this Agreement shall not affect the validity or enforceability of any other provision hereof. m. Consultant shall maintain for a minimum of three years, adequate financial and other records for reporting to County. Consultant shall be subject to financial audit by federal, state or county auditors or their designees. Consultant authorizes such audits and inspections of records during normal business hours, upon 48 hours' notice to Consultant. Consultant shall fully cooperate during such audit or inspections. n. The signatories to this Agreement aver to their knowledge, no employee of the County has any personal or beneficial interest whatsoever in the Services or Property described in this Agleement. The Consultant has no beneficial interest, direct or indirect, that would conflict in any rranner or degree with the perfornrance of the Services and Consultant shall not employ any person having such known interests. o. The Consultant, if a natural person eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (i) is a cinzen or otherwise lawfully present in the United States pursuant to federal law, (ii) to the extent applicable shall comply with C.R.S. 2+76.5-103 prior to the effective date of this Agreement. 15. Prohibitions on Government Conffacts. As used in this Section 15, the term undocumentedindividual will refer to those individuals fromforeign countries not legally within the United States as set forth in C.R.S. 8-17.5-101, et. seq. If Consultant has any employees or subcontractors, Consultant shall comply with C.R.S. 8-17.5-101, et. seq., and this Agreement. By execution of this Agreement, Consultant certifies ttrat it does not knowingly employ or contract with an undocumented individual who will perform under this Agreement and that Consultant will participate in the E-verifu Program or other Departrnent of Labor and Employment program ("Department Program") in order to confirm the eligibility of all employees who are newly hired for employment to perform Services under this Agreement. Consultant shall not: i. Knowingly employ or contract with an undocumented individual to perform Senrices under this Agreement; or ii. Enter into a subconffact that fails to certify to Consultant that the subcontractor shall not knowingly employ or contract with an undocumented individual to perform work under the public conftact for services. 9 Eagle County HHS Prof Serv Final 5/14 b, consultant has confirmed the employment eligibility of all employees who *-" -n:Ily hired for employment to perform Services under this Agreement through participation in the E-verify Progfam or DepartnentProgr*, as administered by the United States Depaffinent of Homeland Security. Information on applying for the E-verify progtam can be found at: c. consultant shall not use either the E-verify program or other Deparfinent Program procedurestoundertakepre-employmentscreeningofjobapplicantswhilethepublicconffactforservices is being performed. d.IfConsultantobtainsactualknowledgethatasubconfiactorperformingworkunderthe public confiact for services knowingly employs or.oot *t, with an undocumentedindividual' Consultant shall be required to: i.NotifythesubconffactorandCountywithinthree(3)daysthatConsultanthas acaral knowredge that the subcon*actor is emptoying or eontracting with an undocumented individual; and ii. Terminate the subconffact with the subconfractor if within three days of receiving the notice required pursuant to subparagraph (i) of the paragraph (d) the subconffactor does not stop employing or conffacting with the undocumented individual; except that consultant shall not terminate the contract with the subcontractor if during such three (3) days the subconftactor provides information to establish that the subcontractor has not towingly employed or contracted with an undocumented individual. e.consultantshallcomplywithanyreasonablerequestbytheDepaltrnentofLaborand Employment made in the course of an investigation that the department is undertaking pur$uant to its authoriq' established' in C.R.S. 8- 1 7'5 -102(5)" f. If consultant violates these prohibitions, county may terminate the Agreement for breach of contract. If the Agreement is so terminated specifically for breach of this provision of this Agreement' Consultant shall be liable for actual and consequential damages to County as required by law' g. county will notify the colorado secretary of state if consultant violates this provision ofthisAgreementandCountyterminatestheAgreementforsuchbreach. 10 Eagle County ltr{S ProfS€rv Fnal 5/14 IN WITNESS WtmREoF, the parties have executed this Agreement the day and year first set forth above. COI.]NTY OF EAGLE, STATE OF COLORADO' By and Through Its COUNTY MANAGER By: Print Name: Tifle: 0Uf,f\otL CONSULTANT: JESSICAW 11 Eagle County IIHS Prof Serv Final 5ll4 EXHIBIT A SCOPE OF SERVICES, SCI{EDULE, FEES Descriution of Servics: This contract is for services provided begtnning on January t, 2016 and ending Decefiiber 31,zo71.Connactor will provide Fluman Services Mental Healttr Services, Early Head Start Health coordination, and early childhood research assistance. @: 1. Mental Health Services: Contractor must possess a Master's or Doctorate in Psychology, Counseling, or Social Work and possess one of the following credentiats MSW, LCS'IV, LS1il', or LPC. Z. Mental Health Services: Contractor will provide Early Head Start Mental Health Coordination for families, children, parent educators and teachers. Including but not limited to oversight and development of social-emotional screening tools, assessments, and service plans, observations of children with sacial-em*ti*nal corlcerns, previding cans*ltatia* tc families demonstrating mental health concems, identification of concerns through screens or direct referral, providing staff mental health support both to parent educators and teachers, availability to provide mental health education to staff andfamilies. 3. Early Head Start Health Coordination: Contractor will have access to ChildPlus database and must input immunizations and well child check information. 4. Early Childhood Research Assistance: Contractor will research best materials for Early Childhood development to a variety of audiences to inform and generate more champions for Early Childhood Development in Eagle County. Researcher will bring the range of recommended materials to Human Services and once final selection is made, contact originators of materials, as needed, for copyright authorization. These materials align to Great Place to Live for All, Objective, expand early childhood opportunities. Payment and Fee Schedule: Contractor shall be compensat€d for performance of assigned services as follows: l. County aglees to pay to Contractor $80 per hour for mental health serrrices' Said payments to Contractor shall not exceed $11'000. 2. County agrees to pay to contractor $50 per hour for health coordination services. Said payments to Conffactor shall not exceed $1'000. 3. County agrees to pay to Contractor $50 per hour for emly Childhood Resemch Assistance. Said payments to Confactor shall not exceed $Sfi). Fees and reimbursements will be made in accordance with the terms of paragraph 5 of the Agreement' L2 Eagle County t*IS Prof Serv Final 5lL4 EXHIBIT B Insurance Certfficate 13 Eagle County HHS Prof Serv Final 5/14 Certificate of Insurance (Proof of Coverage) Date Issued: 0210512016 THIS CERTIFICATE IS TSSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. COVERAGE AFFORDED BY THE POLICIES BELOW Description/Special Provisions: General Liability Insured Location(s): 5l Eaele Rd 3 Suite 2 Eacle-Vai co 81620 DISCLAIMER:The Certificate oflnsurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon. HIS UERITIIUAII, T,UUS NUI A trxIt ND.URALtt K IHts A lnsured Name and Mailine Address*Program Administrator Jessica Waclawski po box I 776 Avon. CO 81620 Administered By: CPH and Associates 71 1 S. Dearborn, Suite 205 Chicago, IL 60605 P. 312-987 -9823 F. 312-987-0902 info,@cnhins,com Underwritten By: Philadelphia Indemnity Insurance Comnanv 'Additional insured locations are often requested by individual business owners who have more than rne office. Your coverage is portable, meaning that you are covered at any location for practice under he occupation(s) listed on your policy. Coverase )olicv #: E217822 lEffective Date: 09 I l2l20l 5 lExpiration Datez 09 I l2l20l o rHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDICATED. NOTWITHSTANDING AIVY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH TESPECT BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. \GGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits of Liabilitv Coverage ParlEACH OCCURRENCE (Per individual claim) AGGREGATE (Total amount per policy year) $1.000.000 $3.000.000 Professional Liabilitv $l,000,000 $3.000.000 Commercial General Liability Includes: General Liability, Fire & Water Legal Liability and Personal Liabilitv N/A N/A Propertv Coverage $1.000.000 $3.000.000 Supplemental Liabilitv Unlimited Unlimited Defense Expense Coverage $35.000 $35.000 State Licensinp Board Investisation Defense Coverase $l 5.000 $15.000 Assault Coverase $10.000 $35.000 Deoosition Exoense Benefit $5.000/oerson $50.000 Medical ExDense Coverage $ 15.000 $15.000 First Aid Coverage co 81631 ld any ofthe above described policies be cancelled before the expiration date thereof, will be delivered in accordance with the policy provisions. Holder has also been added to the oolicv as an additional insured:** t x Yes/Nol **If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be rsed. A statement on this certificate does not confer rights to the certificate holder in lieu ofsuch endorsement(s). {,f}}f fub' Authorized Representative C. Philip Hodson GiEleEl. colorado lnsurrnce ldentilication Gardgei co. com 1-BOO-841-3OOO GEICO CASUALTY COMPAI{IV:.i:..po Box 509090 sat'I:i:iDrEco. cA 92150-9090 Policy tlumber EfFctive DeiBi. Erpir{aon Dete4230074694 rl--09-T5::iiii:. 05-09-l_6 _y^e!r- Meke moobr:iililii ' vehicte tD t{o.2000 rEEp wRAcri$: spr 1j4FA49s7yp752287 Inau6d: ::.'::.:::::: JESSTcA tlqEL WAcLAWSKliiiiii:i PO BOX 863 'ii'iiiiEAGLE, co 81631_-01_91.,...,,ii,iii., The abow iasrmce compmy hru isrued * tr*." p"Lrcy which mmplies with the minimm liabillty limits presoibed by law, Important Informatlon Here are your Policy ldentification Cards. Please destroy your old cards when the new cards become effectve. Due to space limitrations on fte lD card, only the Named Insured and the Co-insured are listed. For a full list of drfuers covered under this policy, please t€fercnce the Drivers section of lrour Declarations Page, whlch is included with your insurance packet. Please notiry us prornptly of any change In your address to be sure you rseive all important poliry documents. Prompt notificaton will enable us to seMce you better. Your policy ls recorded under the name and policy number shown on the card. lf you would like additional lD cards, you can go online to geico.com or call us at l-800€41€000. tlUhat to do at the time of an eccident Do not admit fault Do not reveal the limits of your liabili$ coverage b anyone. Erchsnge contac{ inlbrmation; getyear, make, model, plate number, insurance canier and pollry number of all inrrohed. Also, identiff witnesses and colled csrtact informatlcn. Gontad the police or 911 if applicable. Contact GE l@ by calling I {00€rtl €000 or visit geico.comto report the aocldent u4€o(r2{,9)